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Fifteen years after the first report, laparoscopic nephrectomy has demonstrated proven efficacy and safety comparable with an open approach, with a significant advantage of a faster recovery. Wide dissemination of these surgical techniques and continued improvement in instrumentation has made laparoscopy the preferred approach for treating benign pathologic conditions of the kidney. In this review, the expanding indications of laparoscopic simple nephrectomy and the outcomes of the larger clinical series are examined. We discuss the technical aspects of both transperitoneal and retroperitoneal approaches. Finally, laparoscopic cyst decortication and some of the novel applications of laparoscopic renal surgery are highlighted.

The technical challenges of performing laparoscopic renal surgery require fellowship training and are associated with a steep learning curve. For the established urologist in practice, fellowship training is not a reality. As a result of these obstacles, in the late 1990s, laparoscopic renal surgery was entering the domain of the general surgeons who had a large number of laparoscopic procedures at their disposal to develop laparoscopic skills. Handassisted laparoscopic renal surgery is a hybrid procedure combining the most salient features of open renal surgery and laparoscopic renal surgery. By allowing the surgeons to place their non-dominant hand into the abdominal cavity, palpation and spatial orientation became possible, lessening the learning curve for laparoscopic surgery. Moreover, hand-assisted laparoscopic surgery could be applied to a variety of renal surgeries, extirpative and reconstructive, with results similar to those already achieved by standard laparoscopy. Throughout the past 5 years, hand-assisted laparoscopy has allowed urologists to incorporate laparoscopic renal surgery into their practices to the benefit of their patients and of their specialty. This review article offers a historical review of the development of hand-assisted laparoscopy and describes the procedures commonly performed today using this technique.

Laparoscopy in pediatric urology is a rapidly evolving field that is becoming part of the operative repertoire of an increasing number of pediatric urologists. This article summarizes the latest ideas and issues in the expanding field of laparoscopy in pediatric urology. New methods of obtaining laparoscopic access and retraction are discussed. Laparoscopic experiences in urologic reconstruction, diag-nosis and treatment of the nonpalpable testis, renal surgery, ureteral reimplantation, varicocelectomy, hydrocelectomy, and herniorrhaphy are reviewed. Articles assessing the safety of a pneumoperitoneum in patients with a ventri-culoperitoneal shunt are also discussed.

Percutaneous nephrolithotomy (PCNL) is the gold standard for the treatment of large renal calculi. Recently, modifications to the standard PCNL with nephrostomy tube placement have evolved, most notably the introduction of tubeless PCNL. Tubeless PCNL appears to decrease postoperative discomfort and shorten hospital stays, without increasing complication rates in the appropriately selected patient population. Urologists have attempted to expand the role of tubeless PCNL in more complex clinical scenarios, including pediatric and geriatric patients, and in stones complicated by multiple access tracts, renal anomalies or previous renal surgery. In an attempt to further improve outcomes following tubeless PCNL, adjunct interventions such as the use of hemostatic agents along the percutaneous access tract and local tract anesthetic have also been evaluated. We report the most recent published data over the past year, reviewing the employment and efficacy of tubeless PCNL, and discuss the selection of appropriate patients for this modified procedure.

Renal tumors are being detected at increasing rates because of widespread use of modern imaging techniques such as ultrasonography and computed tomography. Typically, these tumors, many of which are discovered incidentally, tend to be small and are confined to the kidney. Advances in ablative and imaging technology have led to the application of minimally invasive therapy in the treatment of small renal tumors. Although still evolving as a cancer treatment, minimally invasive treatment potentially offers several advantages over conventional open renal surgery: shorter convalescence, improved cosmesis, reduced postoperative pain, and renal preservation. This article reviews the status and recent progress of minimally invasive approaches to renal neoplasm.